Provider Demographics
NPI:1407942030
Name:PARKER, KENNETH A (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:PARKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 HERMANO DRIVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4516
Mailing Address - Country:US
Mailing Address - Phone:818-708-8345
Mailing Address - Fax:
Practice Address - Street 1:4710 HERMANO DRIVE
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4516
Practice Address - Country:US
Practice Address - Phone:818-708-8345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 6485103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist